The role of the LenSx® femto laser in difficult cataract surgeries

Session Details

Session Title: Femto Cataract II

Session Date/Time: Monday 15/09/2014 | 14:30-16:30

Paper Time: 16:10

Venue: Boulevard B

First Author: : O.Moraru ROMANIA

Co Author(s): :    I. Iliescu              

Abstract Details

Purpose:

Initialy designed for regular/routine cataract surgeries to deliver true refractive results with high precision and reproductibility, LenSx® femtolaser finds its lately utility and cost effectiveness in difficult cataract cases. Our paper evaluates the surgical course and outcomes in difficult cataract surgeries using the LenSx® Laser.

Setting:

Oculus Eye Clinic- Bucharest, Romania

Methods:

Patients who would benefit of a femtolaser cataract surgery were divided into 5 groups. The first group included patients with hard or intumescent cataracts (4 patients), the second group patients with small pupils (3 patients), the third- patients with small pupils and low endothelial cell count (2 patients), the forth group patients with hard cataracts and low endothelial cell count (2 patients) and the fifth largest group patients with small pupils, hard cataracts, zonular laxity , +/- low endothelial cell count, +/- low antherior chamber depth (7 patients). All patients received femtolaser cataract surgeries and the laser procedures and the surgeries have been recorded. We followed the capsulotomy patterns, the nuclear fragmentation and laser energy levels, the surgical course and outcomes and also the postoperative 1 month results. For all patients with small pupils we lowered the capsulotomy size down to the lowest 3.7mm and the lens chop diameter size down to 3.6mm. For patients with hard nuclei we used energy levels up to 15µJ in order to fragment the lens and to lower the further ultrasound energy levels. All eyes received soft shell endothelial cell protection and the facoemulsification was done using the CENTURION® Vision System.

Results:

All cataract surgeries were uneventfull with the eventual in the bag IOL implantation. Among the hard nuclei cataract surgeries the highest CDE was 22.18. For the white, intumescent cataracts all capsulotomies were complete with no risk for an Argentinian flag sign. In the small pupil groups we didn’t need any iris hooks to further dilate the pupil and the facoemulsification was possible with lowered risks due to the prechopped nuclei.(We didn’t need any blind maneuvres to chop the nucleus under the iris). Among the groups with eyes with low endothelial cell count we had no corneal oedema first day postop. In the last group, for the patients with zonular laxity we didn’t need capsular hooks during facoemulsification of the nuclei and, at the end of surgery, 4 patients received capsular tension rings. At 1 month follow-up we achieved good refractive and visual results with no IOL descentration or other late postoperative complications.

Conclusions:

Despite the initial controversies related to the high costs and its doubtfull clinical and surgical advantages, the femtosecond laser finds its place in difficult cataract cases. Even for the most experienced surgeons, the hard nuclear cataracts, with small pupils, low endothelial cell count and loose zonules still pose a surgical challenge, and, with the help of the femtosecond laser, we can lower the risks and make the excellent outcomes more reproductible. In this difficult cases we also find the femtolaser cost-effective and its recommendation ethical.

Financial Interest:

NONE